Thursday, November 16, 2017

The Time After Childbirth Is More Dangerous Than You Think. What to Watch For

As soon as visitors arrive in the delivery room, every family member rushes to capture a picture of the tiny newborn and debate which grandparent the wee one most resembles. This beautiful baby instantly becomes the center of everyone’s attention, while the mom suddenly becomes second fiddle. In recent years this same trend has slowly seeped its way into medicine as well. Research dollars have mainly focused on improving outcomes of babies, while we assumed that moms were doing fine on their own. Infant mortality has reached an all-time low, which is wonderful; but a recent analysis by the CDC found that mothers in the United States have a higher rate of dying in the days and months after giving birth than many other developed countries, and this rate has been trending up for the last 20 years. The most disturbing part of the data was the finding that up to 60% of the deaths were likely preventable. Hospitals throughout the country are working diligently to improve systems, but as a patient, there are steps you can take to lower your risks as well.

A healthy pregnancy starts with a healthy mom. Many of the causes of postpartum death are associated with underlying medical conditions like heart disease, high blood pressure, diabetes, depression, substance abuse and obesity. Meeting with your doctor BEFORE you get pregnant to optimize your health is extremely important for a healthy pregnancy AND postpartum recovery.

The leading cause of postpartum death is hemorrhage (excessive bleeding) that is not recognized and treated quickly enough. Your doctor will massage your uterus and give you oxytocin through your IV after delivery, which helps reduce bleeding postpartum. As a patient, there is not much you can do to fully prevent postpartum hemorrhage, but you can be aware of the symptoms and be prepared. Check with your provider to see if your hospital has a hemorrhage protocol in place to protect you while you are in the hospital. Hemorrhage can occur up to two weeks postpartum, though. It is normal for your bleeding to wax and wane for several weeks after delivery, but if the bleeding gets heavy and you begin soaking large pads more than once an hour, that could be a sign of delayed postpartum hemorrhage. You should call your provider or go to the hospital.

Infection is the next leading cause of death. Obesity and diabetes are risk factors for postpartum infection. Minimizing weight gain and keeping diabetes well-controlled can reduce your risk of skin and uterine infections. Another cause of death by infection is the flu, so getting your flu shot and washing hands frequently protects not only your baby, but you as well. Sepsis (a life threatening reaction by the body to an infection) is another cause. Symptoms of sepsis include fever, high heart rate, and low blood pressure. You need to confirm that your hospital has a protocol in place to recognize and treat sepsis quickly.

Heart disease is the third leading cause of postpartum deaths. Heart problems in pregnancy can be particularly tricky because many of the concerning symptoms are also common pregnancy symptoms, like swelling or trouble breathing. If you experience chest pain, palpitation, trouble breathing while lying flat, a severe headache (especially if associated with vision changes), or coughing up blood, you should call your doctor or go to the emergency room immediately. If you go back to the hospital, it is especially important that you return to the hospital where you delivered originally so that the doctors have access to you records. If you can’t return to your original hospital, bring your discharge instructions from your hospital stay. Lack of access to the complete medical records was found to be one of the major issues associated with postpartum deaths from heart disease.

The fourth leading cause of death is mental health issues. This especially breaks my heart because these deaths seem very preventable. But the actual problems that cause them – such as postpartum depression, partner abuse, and drug abuse – are often complex and rarely solved with a simple intervention. The stigma around postpartum depression is slowly diminishing, but we still have a long way to go to raise awareness. Symptoms include persistent feelings of sadness, crying spells, thoughts of needing to escape, feeling like your family would be better off without you or thoughts of hurting yourself or your baby. Any of these should prompt an immediate visit to your provider. If you are diagnosed with postpartum depression, it is important to take medications and keep follow-up appointments with your provider. If you are having thoughts of hurting yourself and can’t get to a doctor’s office or emergency room, please call the suicide hotline (1-800-273-8255). If you are in a situation where you are being abused or feel unsafe, please reach out to the domestic violence hotline (1-800-656-4673). If you are struggling with substance abuse, please talk to your provider. They want to help you.

As someone who has dedicated her life to women’s health and childbirth, I found this data about moms dying after birth shocking and disturbing. American moms should not be dying from preventable causes. Doctors, nurses and hospitals are analyzing the data to do what we can to make change, but as a patient, you can also make a difference by doing your best to be healthy and proactive.

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Contributors

Heather Rupe, DO

Heather Rupe, DO, is a board-certified OB/GYN in private practice in Franklin, TN, and serves as the vice chief of staff at Williamson Medical Center. She is the co-author of The Pregnancy Companion: A Faith-Filled Guide for Your Journey to Motherhood and The Baby Companion: A Faith-Filled Guide for Your Journey through Baby’s First Year.

Arefa Cassoobhoy, MD, MPH

Arefa Cassoobhoy, MD, MPH is a board-certified internal medicine doctor and a WebMD Medical Editor. She is on the team that makes sure all WebMD content is medically correct, current and understandable. She sees patients at the Women’s Wellness Clinic at the Atlanta Veterans Affairs Medical Center.